Provider Demographics
NPI:1023202546
Name:JACOBSON, BRIAN MORSE (IDC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MORSE
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MCM CREW REAPER
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09501 1905
Mailing Address - Country:US
Mailing Address - Phone:619-647-1718
Mailing Address - Fax:
Practice Address - Street 1:MCM CREW REAPER
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09501 1905
Practice Address - Country:US
Practice Address - Phone:619-647-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman